lactation and maternal health

Question 1

Pregnancy weight gain recommendations

Answer 1

BMI <18.5 : 28-40 lbs
BMI 18.5-24.9 (normal) : 25-35 lbs
BMI 25-29.9 (overweight) 15-25 lbs
BMi >30 (obese) 11-20 lbs

Gain 2-5 lbs in the first three months.
Gain 1 lb/week thereafter
Lbs to Kg = lbs/2.2
Kg to lbs = Kg x2.2
BMI = 703 x weight in pounds/height in inches.

Question 2

Pregnancy nutrient needs:

Answer 2

Specific nutrient needs:
Macros: CHO, Protein, lipids

Protein increased need: 1.1 g/kg/ day or an additional 25 grams above non pregnant

Lipids:
1. DHA: 300 mg per day (3 letter in DHA) fetal growth and cognitive development.
2. Iron: At least 27 mg per day (some women supplement with 30 mg of ferrous sulfate per day)/ double in pregnancy
a. screen for anemia (transports oxygen throughout the body)
b. cleft palate, abnormal development.

3. Folic acid (B9): 600 mcg a day (200 from food, 400 from supplement), neurological
   a. breakfast, rice, bread, spinach, OJ
4. Calcium :
   -18 years old or younger: 1300 mg
   - older than 18 years old : 1000 mg per day.
5. Zinc: cleft oral, congenital abnormalities, fetal growth, miscarriage.
   a. foods: red meat, seafood, whole grains, fortified cereals,
   b. vegans may need to supplement more.

Pregnant teenagers require more Zinc, Iron and Calcium (ZInC)

Calories:
Second trimester: +340 cal
Third trimester: +452 cal

Question 3

Things to FADE during pregnancy

Answer 3

1. Fish (SKARS; swordfish, king mackerel, Albacore (limit), Raw fish, Shark) / mercury can cause brain damage , nervous system damage.
2. Alcohol (fetal alcohol syndrome)
3. Deli Meat
4. Excess Vitamin A ( greater than 10,000 IU) Can harm fetus , spontaneous abortion

Question 4

Birth weight classification and Premature adjusted age

Answer 4

Extremely low birth weight: <1000 g (2.2 g)
Very low birth weight: <1500 g (3.3 lbs)
Low birth rate <2500 g (5.5 lbs)
Normal birth rate 2500 g-4000g (5.5 lbs - 8.8 lbs)

To remember all weights in grams, start with 1000 grams, then add 500, then add 1000, then add 1500.

If a baby is born premature, use the chronological age in weeks minus # of weeks born premature to calculate adjusted age.

SGA : <10th percentile
AGA: <10-90th percentile
LGA: > 90th percentile

Question 5

Lactation needs and milk

Answer 5

1. Nutrient needs during lactation
   -First six months : +330 cal
   - 6-12 months: +400 cal
   - protein needs: same as in pregnancy (70-75 g per day)
2. Colostrum:
   -First milk: Yellow tinged fluid satisfies first week nutrition needs.
   - More protein and antibodies than mature breast milk but less carbs and fat.
3. Breast milk is mainly governed by two hormones:
   - PROlactin: PROduces milk
   -OxyTOcin: Allows milk TO flow through ducts
4. adequate milk supply is signaled by things such as an infant producing 6-8 wet diapers or an infant gaining weight and length.
5. Baby friendly hospital intiative:
   -Health facilities especially try to promote breastfeeding.

Question 6

Infant formula

Answer 6

Provides 20 calories per ounce, more protein and iron than breast milk but lacks antibodies.

2.5ounces per pound per day.

infants need at least 1 quart of vitamin D fortified formula per day to meet vitamin D needs.

Should be iron fortified.

Question 7

Foods to avoid for infants

Answer 7

whole grapes, popcorn, unpasteurized milk, cows milk (reserve for 12 months, avoid low fat and skim until 24 months) , hot dogs, honey.

Fruit juice OK after 12 months but limit.

Question 8

Infant nutrient needs

Answer 8

Specific nutrients:
-Vitamin D: exclusively breastfed infants need 400 IU
-Iron: storage supply depletes by 6 months, need supplement iron
-calories: 0-6 months: 108 calories /kg; 7-12 mo: 98 calories

-protein: 0-6 months: 9.1 g per day; 7-12 months: 11 g per day.

-Fat: 0-12 months: at least 30 grams per day.

Question 8

Which hormone is responsible for milk synthesis during lactation’
1. oxytocin,
2. estrogen
3. prolactin
4. progesterone

Answer 8

1. Oxytocin: Love hormone, causes muscle to contract around cells which pushing milk through cells. Responsible for let down. contracting milk producing cells and pushing milk through ducts.
2. estrogen: dveloping sex characteristics, produced in placenta,

prolactin: milk production, milk synthesis

progesterone: maintain pregnancy, helps make milk producing cells during pregnancy. produced in placenta. interferes with milk production.

once placenta is delivered, progresterone drop, prolactin increase, oxytocin push milk through cells.

Placenta left over: progesterone can stay elevated which will limit prolactin

Question 8

difference between human milk and infant formula

Answer 8

human milk :
20 calories per ounce.
contains antibodies that help fight bacteria and viruses, infections.
passive immunity: antibodies in mom’s body pass antibodies to baby.
-less caloric dense in morning, but higher volume.
-later in day, less volume, higher calorie.
-lower in protein than infant formula.
-human milk more bioavailable and easier to digest.
- Iron supplement until 6 months of age.

infant formula: 20 calories per ounce
HIgher in iron

cows milk not recommended until one year of age.